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Nipple tattooing is the latest example of the tinkering with bodies that remains shamefully under-regulated

From the annals of romantic literature by liberal Canadian politicians who once presented late-night BBC2 arts programmes (and wrote a column on these pages), one line has, inexplicably, stayed with me. It appears early in Asya, “the compelling account of one indomitable woman’s path through revolution, war and exile”, by Michael Ignatieff. Asya’s breasts are “perfect”, Ignatieff writes, as they sensuously embark on what will be an action-packed tour of the 20th century. “When she looked down at them, at the little ellipses with their raspberry nipples awaiting the touch of his hands, she began to laugh.”

Ellipses? Raspberries? His heroine’s curious perspective on these assets suddenly came to mind last week, for the first time since Asya‘s publication in 1991, courtesy of a new report that nipples have joined the long list of healthy female body parts available for safe and legal reconfiguring by British plastic surgeons. Perhaps Ignatieff’s nipple aesthetic, far from being, as it then seemed, a stand-out personal fantasy, is actually a widely shared ideal. Either way, brightly coloured, Ignatieff-style nipples can now become reality for everywoman, thanks to a tattooing technique initially developed for patients undergoing breast reconstruction.

Tittooing is the vulgar name for a kind of colouring that has been popularised, according to a Telegraph report, in Liverpool, where a specialist, Gail Proudman, told the paper she improves three pairs of nipples a week, for up to £1,200 a pair. “A lot of people want their nipples made darker,” she explained. “It’s the fashion.” It says something about Liverpudlian spirit that its cosmetic daring has even caused a stir in the US, creator of Michael Jackson and the Bride of Wildenstein.

Asked his opinion, a professional from the British Association of Aesthetic Plastic Surgeons (BAAPS), Mr Graham Offer, issued the kind of tip that has already done so much to pathologise other body parts: make sure you use a properly qualified practitioner. You can see his difficulty. Although there was a discernible lack of enthusiasm in his advice – “I’d recommend people give it consideration and thought”– a spokesman for BAAPS can hardly condemn, outright, a procedure that is no more stupid or offensive than most of the other bits of pointless surgical tinkering advertised on its members’ websites.

If they came out against tittooing, BAAPS surgeons would be hard-put to defend earlobe redesign and chin implants, elective genital surgery and breast augmentation, to say nothing of promising, but yet-to-be exploited zones of female shame and neurosis such as neck width, tongue colour and tear size. If they denigrated Liverpudlian fashion as an excuse for pallid nipples to join the admissible “areas of concern” (the aesthetic surgeon’s technical term for assailable female body parts), these professionals would immediately jeopardise the solitary justification for, say, thigh-gap surgery, a profitable new area since the Twitter account @CarasThighGap raised awareness of non-gap deformity.

“Inner-thigh liposuction is a common area of concern among many women who visit my clinic looking to have the procedure,” sympathises prominent plastic surgeon Alex Karidis. “Following the procedure, the patient will be able to instantly see and feel a difference.” And when thigh gaps cease to be on trend, one of Mr Karidis’s colleagues, is sure to be on hand, as with changing breast-size fashions, with finest, French-made thigh implants or injections of human body fat from the underground lake beneath Harley Street.

As it stands, the only limit on the aesthetic surgical imagination appears to be that of human gullibility. Even the revelation, in 2010, that British surgeons had been – completely inadvertently –cutting open women’s chests and filling them with pouches of leaky, mattress-grade silicone only reduced the number of breast augmentations in 2012 by 1.6%. It probably helped that Professor Sir Bruce Keogh, the NHS medical director, concluded that PIP implants presented no long-term threat to health. This view has very recently been challenged in a study of removed PIP implants conducted by nanotechnology professor Alexander Seifalian and plastic surgeon Peter Butler. The state of the implants, the authors concluded, “supports the argument for prophylactic removal”. But the NHS is sticking to laissez-faire and, to judge by his provisional remarks about “poor practices” and “unreasonable risks”, an imminent review of plastic surgery by Keogh, commissioned as a result of PIP, is most likely to focus on stopping amateur and barely trained practitioners, as opposed to regulating the stuff you can legally inject or stuff inside patients. For plastic surgeons, an enhanced reputation for safety that might follow firmer practitioner regulation could be actively liberating.

Unless, which seems unlikely, Keogh insists on more demanding psychological assessments, a greater emphasis on training could further normalise the idea that, so long as it’s professionally done, attacking healthy tissue, in order to recreate Cara Delevingne’s legs, Kate Middleton’s nose or a fantasy created by undiagnosed body dysmorphic disorder, is a responsible medical enterprise. Given professional backing, pallid nipples may come to be seen as pathologically unfortunate, as are very small breasts or wrinkled female hands.

Of course, it is every British woman’s right to pay, if she wants, to have her ordinary-sized breasts augmented or her toes shortened, while her face is modified by fillers that are illegal in the US, but admirers of tribal scarification, which is banned in the UK, must wish they enjoyed a similar freedom to butcher themselves. In the absence of searching psychological examination and of any notion of physical norms within which surgical profiteering is ethically indefensible, clinicians are free to trade in modifications that, safety aside, may never fulfil expectations.

Their websites specialise in compare-and-contrast photographs and testimonials where “before” looks either better or utterly indistinguishable from “after”. But this, against cautionary tales from surgery addicts, poor outcomes for patients with unrealistic expectations, and the ongoing PIP scandal, appears to be all aesthetic surgeons feel obliged to offer prospective patients, in the absence of evidence of long-term benefits to well-being.

In France, the trial of Jean-Claude Mas, the repellent former cognac and sausage salesman who made his fortune in PIP implants, exposes an unimaginable contempt for women. But there, at least, the government has agreed, as a precautionary measure, to remove the implants, free of charge. Germany, Venezuela, the Czech Republic – and Wales – have done the same. In England, where Keogh proposes to hammer the cosmetically untrained, at least one supposedly reputable clinic has successfully restructured their businesses, so as to escape responsibility for PIPs. And the NHS is happy to wait and see how many prostheses eventually leak their contents in situ.

While safety remains a priority in pharmaceuticals and, say, Leeds heart operations, women’s bodies are condemned to host the fluids that Mas used to hide out of sight of the police. So, in this context, Liverpudlians are probably right: why fuss about a spot of irreversible nipple tattooing? © 2013 Guardian News and Media Limited or its affiliated companies. All rights reserved. | Use of this content is subject to our Terms & Conditions | More Feeds


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